MEDICARE: IVAN G MELENDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H5188	TX
2	207P00000X	Emergency Medicine Physician	H5188	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00258990	OTHER	TX	RAILROAD MEDICARE
8	319701ZW6Z	OTHER	TX	MEDICARE -IVANA
9	P01802108	OTHER	TX	RR MEDICARE- IVANA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139915634	OTHER	TX	INDIVIDUAL CHSCN
2	8GK771	OTHER	TX	BCBS - IVANA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8U5314	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1568447233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN G MELENDEZ M.D.

Provider Business Mailing Address
First Line	:	1018 BEECH AVE STE 100
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-4547
Country	:	US
Telephone Number	:	956-800-5171
Fax Number	:	956-800-5178

Provider Business Practice Location Address
First Line	:	1018 BEECH AVE STE 100
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-4547
Country	:	US
Telephone Number	:	956-800-5171
Fax Number	:	956-800-5178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/21/2023

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